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Prognostic significance of blood pressure variability in essential hypertension
1Ospedale Generale Regionale 'R. Silvestrini', Area Omogenea di Cardiologia e Medicina, Perugia, Italy.
Insights
High blood pressure variability is linked to increased cardiovascular events in essential hypertension patients. However, this association becomes non-significant in multivariate analysis due to factors like age and diabetes.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Epidemiology
Background:
- Blood pressure variability (BPV) is implicated in target organ damage in essential hypertension.
- Its independent prognostic value for cardiovascular morbidity and mortality requires prospective evaluation.
Purpose of the Study:
- To investigate the association between BPV, measured by 24-hour ambulatory blood pressure monitoring (ABPM), and the incidence of cardiovascular events.
- To assess the relationship between BPV and target organ damage, including left ventricular mass.
Main Methods:
- A prospective observational study of 1372 individuals with essential hypertension.
- 24-hour ABPM was used to assess daytime and night-time systolic blood pressure variability.
- Participants were followed for up to 8.6 years for major cardiovascular events.
Main Results:
- Higher BPV was associated with greater target organ damage and increased left ventricular mass.
- Individuals with high BPV exhibited a higher rate of cardiovascular morbid events compared to those with low BPV.
- In Cox multivariate analysis, BPV did not independently predict cardiovascular events, unlike age, diabetes, prior events, and average night-time systolic pressure.
Conclusions:
- Increased BPV is associated with cardiovascular complications in essential hypertension.
- However, its independent prognostic significance is masked by confounding factors such as elevated blood pressure, older age, and diabetes mellitus.
Abstract:
BACKGROUND: Blood pressure variability is a determinant of target organ damage in essential hypertension, but its independent prognostic significance has not yet been assessed in prospective studies of cardiovascular morbidity and mortality. OBJECTIVE: To assess the relationship between blood pressure variability, assessed non-invasively using 24 h ambulatory blood pressure monitoring and subsequent incidence of cardiovascular morbid events in persons with essential hypertension. DESIGN: Prospective observational study. PATIENTS AND METHODS: We followed for up to 8.6 years (mean 2.92) 1372 individuals with essential hypertension whose initial off-therapy diagnostic work-up included 24 h non-invasive ambulatory blood pressure monitoring. Those with a standard deviation of daytime or night-time blood pressure below or above the group mean were classified as having low or high blood pressure variability, respectively. One hundred and eighty-two participants underwent repeated ambulatory blood pressure monitoring and echocardiography during follow-up, 2.7 years later. RESULTS: Target organ damage score was greater in the participants with high variability of daytime (P = 0.004) and night-time (P = 0.011) systolic blood pressure than in those with low blood pressure variability. In those who underwent repeated echocardiography, for every quartile of baseline ambulatory blood pressure, left ventricular mass at follow-up was greater (all P < 0.05) in those with high baseline blood pressure variability than in those with low baseline variability. During follow-up there were 106 major cardiovascular morbid events. Event rate was 1.99 and 3.26 events per 100 patient-years, respectively, in participants with low and high variability of daytime systolic pressure and 1.98 and 3.38 events per 100 patient-years, respectively, in those with low and high variability of night-time systolic pressure (log-rank test: both P < 0.05). However, in a Cox multivariate analysis, the variability score for daytime and night-time systolic pressure failed to enter the model (age, diabetes mellitus, previous cardiovascular events and average night-time systolic pressure were independently associated with cardiovascular events). CONCLUSION: Increased blood pressure variability, assessed with non-invasive monitoring, is associated with a higher incidence of cardiovascular morbid complications of hypertension, but also with a higher blood pressure, older age and a higher prevalence of diabetes mellitus. Because of the relevant predictive effect of these associated factors, the adverse prognostic significance of increased blood pressure variability is no longer detectable in multivariate analysis.